This inspection took place on 23 July 2017 and was announced. The last inspection took place on 08 September 2015 when the service was rated as ‘Requires Improvement’. There were four breaches of the regulations in relation to safe care and treatment, infection control, safeguarding and good governance. The service had produced an action plan and at this inspection we found significant improvements in all areas.

Eden House is a small residential and day care service for people who have learning disabilities. It is situated in a large five bedroomed property set in its own grounds in Droylsden, Greater Manchester. At the time of our inspection there were four people who lived there permanently, but two of these were on holiday. A fifth person was staying as a guest on respite care.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a warm and friendly atmosphere at Eden House, the home was secure and people told us they felt safe. Staff were familiar with the local authority safeguarding policy and procedures and when allegations of abuse had been made these were investigated.

There were sufficient staff to meet needs, and we saw that recruitment procedures ensured that staff were recruited safely. People who used the service were involved in both the recruitment process and new staff induction to their role.

People’s care records contained detailed information to guide staff on the care and support to be provided. They also showed that risks to people's health and well-being had been identified, and gave detailed instruction to staff to minimise the risks.

The staff we spoke with had an in- depth knowledge and understanding of the needs of the people they were looking after. We saw that staff provided respectful, kindly and caring attention to people who used the service. They ensured that they followed effective procedures to limit the spread of infection, including use of personal protective equipment. Staff were trained to administer medicines and we saw procedures were in place to ensure the safe management of medicines.

Staff understood issues around capacity and consent, and offered people choices to support their independence. People who did not have family or representatives and were not always able to speak for themselves had access to advocates who gave independent advice and acted in the person’s best interest.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a detailed handover meeting took place at the start and finish of every shift to ensure that care and support was provided in accordance with people’s changing needs.

People who used the service planed the menu, and told us the food was good. We saw that attention was paid to ensure people maintained a healthy and nutritious diet. We saw that staff monitored people’s physical and mental health needs, and ensured they had good access to healthcare staff.

People were treated in a caring and compassionate manner, by cheerful staff. One person who used the service told us, “It’s fabulous; I am free to do whatever I choose. If they asked me to leave I’d say no, it’s the best place I’ve lived in by far.” Care was person centred and delivered by staff who understood how to interact with the people who used the service. We saw people were comfortable and looked well cared for by staff who knew them well.

All the people who used the service had been referred to Eden House because their behaviours had been challenging at other service provision. However, there were few instances of challenging behaviour. Care plans reflected people’s needs

We inspected this service on the 8th September 2015. This was the first inspection since the home was registered in September 2014. The inspection was unannounced which means they did not know we were coming to the service to undertake an inspection.

Eden House is a detached property in the Droylsden area of Manchester. Accommodation is available to provide live in support for up to five people, on either a long-term or respite basis. Support can also be provided via the service’s day care provision where people come to the service for the day to receive support. These people are routinely people that have previously stayed in the accommodation service and could stay in the provision again. People using the service are primarily people with a Learning Disability.

On the day of inspection there were two people using the residential service and two people accessing day care. Another person on a planned respite stay arrived later in the day.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff ratios were more than adequate to meet the needs of people accessing the service as support was provided on either a one to one or two to one basis, dependent on assessed need.

We found robust recruitment processes were in place to ensure that the right people were appointed to support roles.

Both staff and management had an understanding of safeguarding. However whilst they knew how to report an issue if they became concerned, we found evidence that not every incident that warranted reporting had been escalated accordingly.

We identified a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Accident and incident mechanisms were in place and we found medication administration and management was safe.

Whilst risks had been identified with particular individuals not all had a corresponding risk assessment in place. We also found working practices and some issues with the premises meant that the control of infection was compromised.

We identified breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The induction process for staff ensured they were familiar with people using the service before support was provided on a 1:1 basis. Staff spoke highly about the training and support provided to them and had knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Management, staff and service users had good relationships. We observed staff treating individuals with dignity and respect and noted that improvements to signage around the home would assist with this.

People using the service were referred to as guests and we saw everyone that used the service was offered opportunities to make choices about their daily routines. We found evidence that people had been involved in making decisions about their care and support. Menus were varied and service users had input into these and helped staff with the cooking.

People who used the service accessed events and activities within the community promoted by the service.

We found that some files contained information that would ensure person-centred care was delivered however one file documented conflicting information. Care plans had been amended and re-printed but the reasons for these changes were not always recorded.

Resident meetings were held on a regular basis. The provider sought the views and opinions of people using the service with regards to relevant topics concerning the home and care provided. There was a system in place for the manager to address complaints made to the home.

Staff we spoke with were proud to work for the service and found the registered manager to be supportive. Staff meetings were undertaken and these meetings were inclusive, with staff being able to give their opinions and contribute to the running of the service. Relevant policies and procedures for the service were in place and available for staff.

Whilst some checks of the service were undertaken by the nominated individual we found there was no effective system of regular audits done by the registered manager. This was a breach of Regulation 17 of the Health and social Care Act 2008 (Regulated Activities) Regulations 2014.

In relation to the breaches outlined above you can see what action we told the provider to take at the back of the full version of the report.